Seeck Margitta, Dreifuss Sylvain, Lantz Goran, Jallon Pierre, Foletti Giovanni, Despland Paul-Andre, Delavelle Jacqueline, Lazeyras Francois
Presurgical Epilepsy Evaluation Unit, Functional Neurology and Neurosurgery Program of the University Hospitals Lausanne and Geneva, Switzerland.
Epilepsia. 2005 Oct;46(10):1642-5. doi: 10.1111/j.1528-1167.2005.00259.x.
The exact anatomic and neurophysiologic correlates of idiopathic generalized epilepsy (IGE) in humans are still not well understood, although the thalamus has frequently been invoked as the crucial structure in the generation of primary generalized seizures. The few in vivo magnetic resonance (MR)-based studies in IGE patients suggest an altered cortical/subcortical gray matter ratio, but with no evidence of structural alterations of the thalamus. In this study, we sought to determine the volumes of the other subcortical structures.
The volumes of the caudate nucleus, putamen, pallidum as well as the thalamus were each determined in both hemispheres in 11 patients with various IGE syndromes, normalized for whole-brain volumes and then compared with 15 age-matched controls.
No differences were noted in thalamic volumes, confirming previous reports. However, smaller subcortical volumes were noted in the IGE patients (p < 0.009), mainly due to smaller putamen bilaterally (p < or = 0.015).
It is speculated that the presence of discrete frontal dysfunction, as noted in neuropsychological studies in IGE patients, indirectly supports our results because the putamen projects predominantly to the frontal cortex. Larger studies with more homogeneous patient populations are needed to determine the robustness of these findings and whether they are specific for particular IGE syndromes.
尽管丘脑常被认为是原发性全面性癫痫发作产生的关键结构，但人类特发性全身性癫痫（IGE）确切的解剖学和神经生理学关联仍未完全明确。少数基于体内磁共振（MR）对IGE患者的研究表明皮质/皮质下灰质比例改变，但没有丘脑结构改变的证据。在本研究中，我们试图确定其他皮质下结构的体积。
在11例患有各种IGE综合征的患者双侧半球中分别测定尾状核、壳核、苍白球以及丘脑的体积，将其标准化为全脑体积，然后与15名年龄匹配的对照进行比较。
丘脑体积未发现差异，证实了先前的报道。然而，IGE患者的皮质下体积较小（p < 0.009），主要是由于双侧壳核较小（p ≤ 0.015）。
据推测，IGE患者神经心理学研究中所指出的离散性额叶功能障碍的存在间接支持了我们的结果，因为壳核主要投射到额叶皮质。需要对更同质的患者群体进行更大规模的研究，以确定这些发现的稳健性以及它们是否特定于特定的IGE综合征。
